Tinnitus: The Noise Inside Your Head

Imagine having a noisy neighbor who never stops humming. Or a phone that rings 24 hours a day. Or sitting next to a machine that emits a constant, dull roar. People who have tinnitus – and there are millions – hear ringing, roaring, buzzing or clicking sounds in their ears and have no way to eliminate it. This might sound like just an annoyance, but for some people the noise is constant and can be extremely disturbing. People with severe cases of tinnitus often find it difficult to hear, work, or even sleep.

Tinnitus is not a disease itself, but a symptom associated with many forms of hearing loss and other health problems. The American Tinnitus Association estimates that more than 50 million Americans have experienced tinnitus – either short-term or long-term – at some point in their lives. About 12 million people have sought medical help for the condition, and for 1 to 2 million of them, the situation is bad enough to interfere with normal daily activities.

Causes
Although there is no single definitive cause for tinnitus, there are many possible origins:

Hearing loss
Doctors and scientists have discovered that people with many different kinds of hearing loss also have tinnitus.

Loud noise
Too much exposure to loud noise can damage delicate cells in the inner ear and lead to noise-induced hearing loss and tinnitus.

Medications
More than 200 medicines – including commonly-used ones like antibiotics, antidepressants, anti-inflammatories, aspirin and sedatives – can cause tinnitus.

Health problems
Many circumstances can cause tinnitus. Among these are allergies, kidney function, diet, tumors, and problems in the heart, blood vessels, jaws or neck.

Short-term issues
Temporary conditions that can cause a low-pitched ringing sensation include impacted earwax, ear or sinus infections or perforation of the eardrum.

Physical injuries
Injuries, particularly those that include trauma to the head and neck, can lead to tinnitus.

TMJ disorders
The temporomandibular joint (TMJ), located in the jaw, shares delicate nerve and muscle components with the ears. TMJ difficulties can lead to ear problems, including tinnitus. A good dentist can help you resolve these complications.

Meniere's disease
Tinnitus accompanied by dizziness and hearing loss may indicate Meniere's disease, a chronic inner ear problem.

Acoustic Neuroma
Another more serious cause of ear ringing is acoustic neuroma, a type of benign brain tumor.

Diagnosis
It’s important to see your doctor for a complete examination, including a thorough hearing test, to look for the source of your tinnitus.

To learn more about what is causing your tinnitus, you will likely be seen by an otolaryngologist. Otolaryngologists are doctors who have special training in diagnosing and treating disorders of the ears, nose and throat (this is why they are also called ENT doctors).

You might also see an audiologist, who will test your hearing and fit you with hearing aid if that will help resolve your hearing problems.

Treatment
There is no definitive cure for tinnitus, but scientists and doctors have discovered several treatments that may give tinnitus patients some relief. Not every treatment works for everyone, so you may need to try several to find the ones that help. Treatments might include:

Hearing aids/Implantable hearing systems
Many people with tinnitus also have a hearing loss. Wearing a hearing aid can make it easier to hear by making sounds louder. The better you hear, the less you notice your tinnitus. New implantable hearing systems are available through some specialists. These systems typically consist of two pieces, at least one of which is implanted in the ear. A magnetic or electrical component converts sound into nerve impulses and a receiver transforms these impulses into improved sound perception.

Maskers
Maskers are small electronic devices (they look like hearing aids) that use sound to make tinnitus less noticeable. Maskers do not eliminate tinnitus, but they can make the ringing or roaring seem softer. For some people, maskers hide their tinnitus so well that they can barely hear it.

Drug therapy
A wide range of medications – including anti-anxiety drugs, antidepressants, antihistamines, anticonvulsants and anesthetics – have been used with varying degrees of success to help control tinnitus. (Ironically, some of these same drugs can cause tinnitus in certain people.) Patients may have to experiment with several drugs or drug combinations before finding the therapy that works best for them.

Counseling
For some people with tinnitus, talking with a counselor or joining a tinnitus support group can help them cope. For instance, cognitive therapists can help patients discover, understand and change their negative reactions to their situation.

Tinnitus retraining therapy
This treatment uses a combination of counseling and maskers that help patient deal with tinnitus by combining masking sounds and counseling. Patients learn to gradually focus on sounds other than tinnitus. This treatment may take 1 to 2 years, but can be very effective – in fact, some patients are eventually able ignore their tinnitus.

Relaxation
Since stress seems to worsen tinnitus, learning to relax can be beneficial. Using biofeedback, for instance, patients can learn to influence body functions such as breathing, muscle tension and pulse to exert some control over the way they react to stress.

Surgery
When the source of tinnitus is a condition such as acoustic neuroma, surgery to remove the neuroma can reduce or end the symptoms.

Self-Help
Avoid anything that can make your tinnitus worse. This includes smoking, alcohol and loud noise. Extremely loud, sudden noises or just spending time in a noisy environment puts people at risk for hearing loss.

If you are regularly exposed to loud noises (for instance, if you work at or near construction sites, airports or factories, or if you use guns for hunting or recreation), wear earplugs or special earmuffs to protect your hearing and keep your tinnitus from getting worse.

If it's hard for you to hear over your tinnitus, ask people to face you when they talk so you can watch their expressions and see them forming words. These signals can give you a better sense of what is being said.

If you know or meet people who have tinnitus, don't take it lightly. Let them know you’re aware of how serious the disorder can be, and ask if there is anything you can do to facilitate communication.

This article includes information from the National Institute on Deafness and Other Communication Disorders and the American Tinnitus Association.

Each year, Medical College of Wisconsin physicians care for more than 180,000 patients, representing nearly 500,000 patient visits. Medical College physicians practice at Children's Hospital of Wisconsin, Froedtert Memorial Lutheran Hospital, the Milwaukee VA Medical Center, and many other hospitals and clinics in Milwaukee and southeastern Wisconsin.